Baena Cristina P, Olandoski Marcia, Younge John O, Buitrago-Lopez Adriana, Darweesh Sirwan K L, Campos Natalia, Sedaghat Sanaz, Sajjad Ayesha, van Herpt Thijs T W, Freak-Poli Rosanne, van den Hooven Edith, Felix Janine F, Faria-Neto José Rocha, Chowdhury Rajiv, Franco Oscar H
aDepartment of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands bPontifical University of Paraná, School of Medicine, Curitiba, Brazil cDepartment of Cardiology dDepartment of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands eDepartment of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia fDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UK *Both authors contributed equally to this manuscript.
J Hypertens. 2014 May;32(5):961-73. doi: 10.1097/HJH.0000000000000136.
Despite the overwhelming evidence supporting the effectiveness of antihypertensive medication, hypertension remains poorly controlled in low and middle-income countries (LMICs). Lifestyle intervention studies reporting effects on blood pressure published from January 1977 to September 2012 were searched on various databases. From the 6211 references identified, 52 were included in the systematic review (12, 024 participants) and 43 were included in the meta-analysis (in total 6779 participants). We calculated and pooled effect sizes in mmHg with random-effects models. We grouped interventions into behavioral counseling (1831 participants), dietary modification (1831 participants), physical activity (1014 participants) and multiple interventions (2103 participants). Subgroup analysis and meta-regression were used to evaluate origins of heterogeneity. Lifestyle interventions significantly lowered blood pressure levels in LMIC populations, including in total 6779 participants. The changes achieved in SBP (95% confidence interval) were: behavioral counseling -5.4 (-10.7, -0.0) mmHg, for dietary modification -3.5 (-5.4, -1.5) mmHg, for physical activity -11.4 (-16.0, -6.7) mmHg and for multiple interventions -6.0 (-8.9, -3.3) mmHg. The heterogeneity was high across studies and the quality was generally low. Subgroup analyses showed smaller samples reporting larger effect sizes; intervention lasting less than 6 months showed larger effect sizes and intention-to-treat analysis showed smaller effect sizes Lifestyle interventions may be of value in preventing and reducing blood pressure in LMICs. Nevertheless, the overall quality and sample size of the studies included were low. Improvements in the size and quality of studies evaluating lifestyle interventions are required.
尽管有大量证据支持抗高血压药物的有效性，但在低收入和中等收入国家（LMICs），高血压的控制情况仍然很差。我们在各种数据库中搜索了1977年1月至2012年9月发表的关于生活方式干预对血压影响的研究报告。从识别出的6211篇参考文献中，52篇被纳入系统评价（12024名参与者），43篇被纳入荟萃分析（总共6779名参与者）。我们使用随机效应模型计算并汇总了以毫米汞柱为单位的效应量。我们将干预措施分为行为咨询（1831名参与者）、饮食调整（1831名参与者）、体育活动（1014名参与者）和多种干预措施（2103名参与者）。亚组分析和荟萃回归用于评估异质性的来源。生活方式干预显著降低了LMIC人群的血压水平，总共涉及6779名参与者。收缩压（95%置信区间）的变化为：行为咨询-5.4（-10.7，-0.0）毫米汞柱，饮食调整-3.5（-5.4，-1.5）毫米汞柱，体育活动-11.4（-16.0，-6.7）毫米汞柱，多种干预措施-6.0（-8.9，-3.3）毫米汞柱。各研究之间的异质性较高，质量普遍较低。亚组分析表明，样本量较小的研究报告的效应量较大；持续时间少于6个月的干预显示出较大的效应量，而意向性分析显示效应量较小。生活方式干预在预防和降低LMICs人群的血压方面可能具有价值。然而，所纳入研究的总体质量和样本量较低。需要改进评估生活方式干预的研究的规模和质量。
